Table 1.
Comparison of guidelines for tricuspid valve surgery
| ACC/AHA guidelines [3]a | ESC guidelines [2]b |
|---|---|
| Class I | Class IC |
| 1. TV repair is beneficial for severe TR in patients with MV disease requiring MV surgery (Level of Evidence: B) | Severe TR in a patient undergoing left-sided valve surgery |
| Severe primary TR and symptoms despite medical therapy without severe right ventricular dysfunctionc | |
| Severe TS (± TR), with symptoms despite medical therapy (Percutaneous technique can be attempted as a first approach if TS is isolated) | |
| Severe TS (± TR) in a patient undergoing left-sided valve intervention (Percutaneous technique can be attempted as a first approach if TS is isolated) | |
| Class IIa | Class IIaC |
| 1. TV replacement or annuloplasty is reasonable for severe primary TR when symptomatic. (Level of Evidence: C)c | Moderate organic TR in a patient undergoing left-sided valve surgery |
| 2. TV replacement is reasonable for severe TR secondary to diseased/abnormal tricuspid valve leaflets not amenable to annuloplasty or repair. (Level of Evidence: C) | Moderate secondary TR with dilated annulus (>40 mm) in a patient undergoing left-sided valve surgeryd |
| Severe TR and symptoms, after left-sided valve surgery, in the absence of left-sided myocardial, valve, or right ventricular dysfunction and without severe pulmonary hypertension (systolic pulmonary artery pressure >60 mmHg) | |
| Class IIb | Class IIbC |
| 1. Tricuspid annuloplasty may be considered for less than severe TR in patients undergoing MV surgery when there is pulmonary hypertension or tricuspid annular dilatation. (Level of Evidence: C)d | Severe isolated TR with mild or no symptoms and progressive dilatation or deterioration of right ventricular functione |
| Class III | |
| 1. TV replacement or annuloplasty is not indicated in asymptomatic patients with TR whose pulmonary artery systolic pressure is < 60 mmHg in the presence of normal MV. (Level of Evidence: C)e | |
| 2. TV replacement or annuloplasty is not indicated in patients with mild primary TR. (Level of Evidence: C) |
ACC/AHA American College of Cardiology/American Heart Association; ESC European Society of Cardiology; MV mitral valve; TR tricuspid regurgitation; TS tricuspid stenosis; TV tricuspid valve
aFrom Bonow RO, Carabello BA, Chatterjee K, et al.: 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008, 118(15):e523–661, with permission of the publisher. (Copyright © 2008, the American Heart Association)
bFrom Vahanian A, Baumgartner H, Bax J, et al.: Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. European Heart Journal 2007, 28(2):230–268, with permission of the publisher. (Copyright © 2007, the European Society of Cardiology)
cDifference in approach to patients with symptomatic primary TR
dDifference in approach to patients with less than severe TR
eDifference in approach to patients with asymptomatic primary TR